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Procedure No. I.C.2.PR.007 Issue Date: January 11, 2002 
Subject:  Individual Support Agreement
Authorization Process 
Effective Date:  Upon release
Revised: July 7, 2003 
Section:  Individual Support 
A. Purpose
To ensure standardized process and documents for the administration of Individual Supports.

B. Applicability
This procedure shall apply to DMR staff with responsibility for Individual Support Agreements and all individuals and sponsoring persons who have Individual Support Agreements (ISAs) with the department.

C. Definitions
(see section definitions)

D. Implementation
With the assistance of a support broker or case manager, the individual or family will complete the Individual Support Agreement as follows:
  1. Regional support broker, case manager, or staff will assemble the following components of the ISA:
a. Individual Support Plan Summary The Plan Summary is a concise one-page overview document that highlights the supports agreed upon in the person-centered planning process.

The Plan Summary is submitted with the ISA (Individual Support Agreement) and the Individual Budget. Please indicate if the ISA is a new agreement, or a renewal. Also indicate the date and the name of the person who prepared the plan summary.
   The Individual Support Plan Summary will consist of the following:
i. Current Situation: A brief description of the person’s current situation including where the person is living, working, or going to school. If the Agreement is a renewal, include a description of the accomplishments of the past year.

ii. Vision: A brief statement of the person’s dream or vision for the future. The person’s dream includes all areas of their life – home, work/school, and relationships, and community life.

iii. This Year’s Action Plan/Rationale: Describe the pieces of the dream that the person and their circle are working on this year and the outcomes the person hopes to achieve. The action plan describes:
  • type of support the person will receive to move closer to his/her desired future
  • why the support is important (what needs will be addressed)
  • how much support (hours, frequency) will be provided
  • who will provide the support,
  • and if the support is paid or non-paid.
Include all supports the person will receive including case manager/broker, home and community supports, day support, respite, family support, and rent subsidy. Be sure to address supports that ensure the person’s health and welfare.
The automated budget included with the Individual Support Agreement packet further delineates DMR-funded supports.

iv. Who Contributed to the Plan: Identify by name and role (broker, relative, friend, agency staff) who contributed to the development of the plan and will assist the person in reviewing and modifying the plan in the future. This must be done at least annually.

v. Waiver Enrollment Status: Indicate if the individual is enrolled in the waiver or the status of the enrollment application if in process. If the individual is not enrolled in the waiver, please state the reason.
b. A copy of the Automated Budget
c. ISA Terms of Agreement and appropriate Schedule(s) signed by the individual or sponsoring person
d. Release of Funds form or other documentation of funding source if required.
  1. Designated regional staff will review the Individual Support Agreement for programmatic and funding completeness. Regional designees will review the plan’s adherence to the Principles and the Essential Features of Self Determination, the ISA Cost Standards, and the Individual Support Agreement Checklist and will make recommendations for approval.
  2. A copy of the approved Individual Support Agreement and all its components should be forwarded to the Regional Director for approval. The Regional Director will review and sign the Individual Support Agreement indicating approval. After the Regional Director approves the Agreement, the finalized DMR Automated Budget should be entered in the Region’s Spending Plan.
  3. Individual Support Agreements that meet the following criteria may be authorized by the Regional Director:
  • The effective date of the ISA or renewal is 7/1/03 or later.
  • The cost of the new ISA or renewal can be covered by the current regional allocation of funds.
  • The plan for supports and services to be purchased under any new, amended, or adjusted ISAs initiated on or after July 1, 2003 adheres to the ISA Cost Standards.  Any items, goods, services, rates or fees that do not adhere to the ISA Cost Standards must be processed according to the ISA Prior Approval procedure. Once prior approval is secured, completed by January 1, 2004 for all renewals and all ISAs approved prior to July 1, 2003.
  • The new ISA or renewal does not exceed the limits identified in the procedures requiring review of residential and day costs or enhanced staffing for individuals. ISAs that meet the criteria for review must be reviewed and approved according to these procedures prior to approval by the Regional Director.
  1. Individual Support Agreements that do not meet the criteria described in number four should be forwarded to the Operations Center for processing and central office approval.
  2. Upon regional or central office approval, the ISA will be copied and returned to the support broker, case manager, or appropriate regional designee.  Copies will be forwarded to the individual or family and fiscal intermediary.  The FI must have a copy of any new or renewed budgets before any payments may be made.  The region shall send a copy of ISAs approved in the region to the Operations Center within two weeks of the date of approval and signature by the regional director.
  3. Operation Center staff will audit a minimum of 20 Individual Support Agreements per region each quarter.  The audit must include a combination of new agreements, renewals, and amendments that were approved by the regional director within the previous quarter of the fiscal year.  The results of the audit will be shared with the Regional Director, Selfdetermination Director, and Assistant Regional Directors.  Themes from regional audits of Individual Support Agreements will be shared with the Deputy Commissioner and the Community and Family Services Division Directors.
E. References
  • Principles of Self-determination
  • Essential Features of Self-determination
  • Individual Budget Procedure
  • Broker Selection Procedure
  • Resource Allocation Procedure
  • Individual Support Planning Procedure
  • Individual Support Agreement
  • Individual Support Agreement Checklist
  • Provider Agreement Guidelines
  • Individual Plan Summary Guidelines
  • ISA Cost Standards